Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Oct 31, 2024
Date Accepted: Mar 4, 2025
Innovating Care for Postmenopausal Women Using A Digital Approach for Pelvic Floor Dysfunctions: A Prospective Longitudinal Cohort Study
ABSTRACT
Background:
Menopause is a life milestone that deeply impacts quality of life and work performance. Pelvic floor dysfunctions (PFDs) affect ~40-50% of postmenopausal women. While pelvic floor muscle training (PFMT) is the primary treatment, adherence barriers leave many untreated, advocating for new care delivery models.
Objective:
Assess the outcomes of a digital pelvic program (DPP), combining biofeedback-assisted PFMT and education, in postmenopausal women with PFDs.
Methods:
This prospective, longitudinal study (N=3051) evaluated engagement, safety, and clinical outcomes (including pelvic floor symptoms and their impact on daily life: Pelvic Floor Impact Questionnaire–short form-7 - PFIQ-7, Urinary Impact Questionnaire–short form 7 - UIQ-7, Colorectal-Anal Impact Questionnaire–short form 7 - CRAIQ-7, Pelvic Organ Prolapse Impact Questionnaire–short form 7 - POPIQ-7, mental health, and work productivity and activity impairment) of a remote DPP among postmenopausal women with PFDs (bladder, bowel, pelvic organ prolapse, or genito-pelvic pain). Structural equation modeling and minimal clinically important change (MCIC) response rates were used for analysis.
Results:
The DPP had a 77.6% (2367/3051) completion rate, high engagement and satisfaction level (8.6/10), and a low number of adverse events (21/3051, 0.69%). Pelvic floor symptoms and their impact in patient's daily lives decreased significantly (adjusted response rate: 59.5% 95%CI 54.9;63.9, unadjusted: 61.0%, N=1125/1843), regardless of condition. Notably, non-work-related activities and productivity impairment were reduced by around half (-18.09 95%CI -19.99; -16.20, 48.3 and -15.08 95%CI -17.52; -12.64, 54.6%, respectively, P<.001). Mental health improved, with 76.1% (95%CI 60.7; 84.9, unadjusted: 65.1% N=97/149) and 54.1% (95%CI 39.0;68.5, unadjusted: 45.2%, N=70/155) of symptomatic patients achieving MCIC for anxiety and depression, respectively. In general, recovery was not influenced by age, body mass index, hormone replacement therapy, social deprivation, or rurality.
Conclusions:
This study supports the value of a remote DPP in improving PFDs, mental health, and work productivity in postmenopausal women, while enhancing equitable access to personalized care. Clinical Trial: ClinicalTrials.gov (NCT05513417), https://clinicaltrials.gov/study/NCT05513417
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.